International Initiative on Thrombosis and Cancer (ITAC-CME)

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

Farge D, Bounameaux H, Brenner B, Cajfinger F, Debourdeau P, Khorana AA, Pabinger I, Solymoss S, Douketis J, Kakkar A.
Lancet Oncol 2016 Oct;17(10):e452-e466.

Abstract

Venous thromboembolism (VTE) is the second leading cause of death in patients with cancer. These patients are at an increased risk of developing VTE and are more likely to have a recurrence of VTE and bleeding while taking anticoagulants. Management of VTE in patients with cancer is a major therapeutic challenge and remains suboptimal worldwide. In 2013, the International Initiative on Thrombosis and Cancer (ITAC-CME), established to reduce the global burden of VTE in patients with cancer, published international guidelines for the treatment and prophylaxis of VTE and central venous catheter-associated thrombosis. The rapid global adoption of direct oral anticoagulants for management of VTE in patients with cancer is an emerging treatment trend that needs to be addressed based on the current level of evidence. In this Review, we provide an update of the ITAC-CME consensus recommendations based on a systematic review of the literature ranked according to the Grading of Recommendations Assessment, Development, and Evaluation scale. These guidelines aim to address in-hospital and outpatient cancer-associated VTE in specific subgroups of patients with cancer.

More about these guidelines

Despite the development of national clinical practice guidelines on VTE treatment in cancer patients, implementation of guidelines has been suboptimal worldwide and thus, substantial knowledge gaps remain. ITAC-CME sought to establish a common international consensus addressing practical, clinically relevant questions in this setting. These updated recommendations also address the use of direct oral anticoagulants (DOACs) in the treatment of VTE for patients with cancer. The 2016 international guidelines provide recommendations for:

Treatment of established VTE

  • Initial treatment of established VTE: first 10 days of anticoagulation
  • Early maintenance (10 days to 3 months) and long-term (beyond 3 months) treatment
  • Treatment of VTE recurrence in patients with cancer on anticoagulant medication
  • Treatment of established central venous catheter-related thrombosis

VTE prophylaxis

  • Prophylaxis of VTE in patients with cancer undergoing surgery
  • Prophylaxis of VTE in medically treated patients with cancer
  • Prophylaxis of central venous catheter-related thrombosis

Special clinical situations

  • VTE treatment in patients with brain tumours
  • VTE treatment in in patients with cancer and thrombocytopenia
  • VTE treatment in in patients with cancer and renal failure
  • VTE treatment in pregnant patients with cancer